While UA can increase access to food, it also has the potential to bolster CCW through cross-cultural social interactions and educational and employment opportunities . Communities can potentially use UA to address health inequities through social and environmental changes .While SDOH may be broadly defined as “the conditions in which people are born, grow, live, work, and age,” Hahn clarifies that SDOH encompasses social resources and health hazards controlled by societal systems which, in turn, have consequences on health outcomes and risks . SDOH can include health-related knowledge, attitudes, beliefs, and behaviors, but these factors are often the result of social factors that are uncontrollable by individuals, such as discrimination . Populations that experience wide disparities in SDOH are affected by health inequities, such as higher risk of disease and earlier mortality . Research suggests that low income and education levels are strong predictors of physical and mental health problems . Socioeconomic status , which can be broadly defined as the combined total measure of a person’s social and economic position in relation to others, is also positively correlated with health outcomes . The following sections will describe SDOH in the context of Long Beach, based on the domains described by The Healthy People 2030 initiative: 1) social and community context, 2) economic stability, 3) education access and quality, 4) neighborhood and built environment, and 5) health care access and quality.The social and community context domain refers to the relationships people have with others. Factors like social support, self-esteem, pipp horticulture and self-efficacy may protect against health risks from adverse social conditions . These protective factors may be fostered through the CCW model . This is especially important for marginalized groups targeted by discrimination .
Those who have a low SES due to social disadvantages, such as discrimination due to race/ethnicity, gender, sexual orientation, and disability, are more likely to suffer from health inequities . Children born into low SES have greater risk of experiencing sudden infant death, infectious diseases, exposure to lead poisoning, household smoke, accidents, and child abuse, which may explain why low SES children have higher rates of asthma, developmental delay, and avoidable hospitalizations . Children from low SES neighborhoods face greater barriers to health-promoting behaviors and often experience stressors from family conflict and economic instability . Additionally, they are at greater risk of being exposed to intimate-partner and community violence. Low SES adolescents report worse health than their peers, experience higher rates of obesity, pregnancy, sexually transmitted disease, depression, and suicide, and more likely to be sexually abused, drop out of high school, or be killed. Compared to those who are more economically advantaged, low SES adults experience higher rates of mental illness, food insecurity, coronary heart disease, and other chronic health conditions, and experience earlier mortality . When discussing SES, it is important to note that in the United States, “race, socioeconomic status, and health have historically been inextricably intertwined” . Federal agencies collect data primarily by race due to Statistical Directive No. 15 of the Office of Management and Budget , originally adopted in 1977 . As of 1997, the directive requires federal agencies in the United States to report statistics for one ethnic category, Hispanic, and five racial groups: American Indian and Alaskan Native, Asian, Black, Native Hawaiian or Other Pacific Islander, and White . United States census data is based on how individuals self-identify to one or more groups, and reflects a general, social definition of race, independent of biological, anthropological, or genetic factors .
For clarification, when this dissertation describes “minorities,” “people of color,” or “communities of color,” this typically refers to non-White racial groups. There is no internationally agreed definition for minority , but in the United States, racial and ethnic minorities are groups of non-European descent: American Indian/Alaska Native, Asian, Black or African American, Native Hawaiian/other Pacific Islander, and Hispanic/Latino . As of 2020, most United States residents identify as White . The U.S. Census Bureau predicts that the nation’s population will become more racially and ethnically diverse, as immigration is projected to surpass birth as the primary driver of population growth. People who identify as more than one race are projected to be the fastest growing racial or ethnic group over the next several decades, followed by Asian Americans and Hispanic/Latino Americans . Over 70% of Long Beach’s population identifies as a racial/ethnic minority, or people of color . About 44.1% of the population is ethnically Hispanic or Latino2 .A stable income is necessary to afford food, housing, and health care. Steady employment can prevent poverty, which is experienced disproportionately among most non-White populations. Compared to 8.2% of non-Hispanic White persons, poverty rates are over twice as high for Black and Hispanic people . Unemployment is strongly associated with worse health and higher mortality, and those who live in poverty are unable to afford health-promoting living conditions . Higher education often leads to employment in jobs with higher compensation, better health care benefits, and safer working conditions. Conversely, those with a lower education are at greater risk of being injured and exposed to hazardous chemicals while working . As mentioned previously, historical redlining practices shaped the neighborhood demographics of Long Beach. For example, housing lenders imposed deed restrictions to prohibit non-White residents to purchase, lease, or occupy property .
Such restrictions were common in East Long Beach and Bixby Knolls, which, decades later, still report lower minority populations than other parts of Long Beach . The National Association for the Advancement of Colored People advocated against such discriminatory housing policies, and worked toward local policy reform in education, employment, economic development, and law enforcement. Their work resulted in the end of racial deed restrictions during the 1960s, though a 1975 study found that unfair housing practices still continued . That same year, Cambodians escaping civil war found refuge in Central Long Beach, which lenders considered risky for investment. Despite this, Cambodians created a commercial district there, and Long Beach became home to the largest Cambodia diaspora. In 2006, the Long Beach City Council officially designated a portion of the city as “Cambodia Town” . Recent data shows that communities of color are still concentrated in North, Central, and West Long Beach. Figure 9 shows a map of Long Beach . The dark purple areas represent where communities of color are the most concentrated.Education increases access to economic opportunities and resources which can influence health . Persons with less than a high school education are expected to live six years less compared to those with a college education . Almost half of all deaths among working-age adults in the United States can be attributed to potentially avoidable factors associated with lower educational attainment, including discrimination in health care settings . In addition to racial/ethnic groups and women, lesbian, gay, bisexual, and transexual groups and persons with disabilities also experience health inequities, which can be attributed to reduced education and employment . Higher education is associated with increased social support, which may benefit physical and mental health by buffering the effects of stress, enhancing health knowledge, and encouraging healthy behaviors . Education level is also highly correlated with health literacy, the ability to comprehend and use information to manage medical care and make informed health decisions . According to Long Beach Unified School District enrollment data from 2021-22, 37,952 students were socioeconomically disadvantaged. The California Department of Education states that socioeconomically disadvantaged students meet at least one of the following: neither parent received a high school diploma, eligible for the Free or Reduced Price Meals Program, are a migrant, homeless, or foster youth, or were enrolled in a Juvenile Court School. In Long Beach, over 40% of residents are Hispanic or Latino, and 12% are Black. Hispanic/Latino and Black families are more likely to have lower educational attainment and quality, due to living in neighborhoods with under-resourced schools . LBUSD enrollment data from the California Department of Education shows that most socioeconomically disadvantaged youth identified as Hispanic or Latino , African American , or Asian/Pacific Islander .Residential segregation forces communities of color into hazardous areas, resulting in detrimental effects on mental and physical health . Neighborhoods with increased social disorder may heighten anxiety and depression . Particularly for poor and Black neighborhoods, health risks are exacerbated by increased exposure to polluted air and contaminated water, because toxic waste facilities, industrial plants, best way to dry cannabis and landfills are often intentionally sited in low SES neighborhoods . Pollution also increases risk of COVID-19 , which, after its discovery in December 2019, became the nation’s third leading cause of death after heart disease and cancer. Compared to non-Hispanic Whites, those who identified as American Indian or Alaska Native, Black, and Hispanic or Latino were about twice as likely to become hospitalized and die from COVID-19 . According to Sprainer , this is because “low-income communities and communities of color across the country are exposed to higher long-term concentrations of an air pollutant that makes COVID-19 more deadly.”
Low SES communities are historically exposed to pollutants due to perceived lack of political power to control zoning, which is controlled by largely white governance structures for industrial development . In urban areas, low SES communities also have less access to green space . Additionally, not all green spaces are equally healthy and well maintained. Data from Su et al. suggested that low-income and minority residents with access to city parks have greater exposure to air pollutants such as nitrogen dioxide , fine particulate , and ozone . Therefore, low SES populations have less opportunity to experience green spaces and their associated benefits, such as improved physical and mental health, and even safer neighborhoods . These patterns of pollution exposure and access to green space can be clearly seen throughout Long Beach. The Long Beach Airport was ranked by the Environmental Protection Agency as having the second highest lead emissions of airports nationwide . Air pollution is further exacerbated by emissions from cars and trucks, particularly those transporting goods from the Port of Long Beach. As seen in Figure 10, areas closest to the port and 710 Freeway, toward the west, have pollution levels of 70- 100%. In comparison, areas of East Long Beach, where the minority population is lower and household incomes are higher, pollution levels are less than 40% .The areas with the highest concentration of minorities, air pollution, asthma, and diabetes are furthest from the largest parks in Long Beach . West Long Beach only has one acre of green space per 1,000 residents . Low SES communities in Long Beach are also susceptible to contamination from industries. For example, an empty lot of upper West Long Beach was used as a sludge dumping ground for oil companies in Long Beach and Signal Hill . This has resulted in years of toxic waste build up, including lead and arsenic. In 2021, local residents opposed developer plans to build a storage facility and requested officials to conduct an environmental impact report. They also argued that the empty lot, which became an area for homeless encampments, should be used to develop a park .The multitude of health risks associated with low SES cannot be addressed by health care alone and may even be exacerbated by discrimination in health care settings . Discrimination perpetuates health inequities by increasing health risks, lowering health care quality, and disrupting the economic opportunities available for low SES populations . There is evidence that people of color in Long Beach, who live in areas with higher air pollution and lower access to green space, have higher hospitalization rates. Long Beach’s hospitalization rates for asthma are higher than that of LA County and California . Data from the Long Beach Department of Health and Human Services also reveals that age-adjusted emergency room rates due to adult and pediatric asthma are over eight times higher for Black residents , than White residents . Asthma rates for the Asian and Pacific Islander population Hispanic/Latinx population were also higher . Figure 11 displays adult and pediatric rates of asthma by ZIP Code.Similar to asthma, hospitalization rates for diabetes are also higher in Long Beach compared to the county and state . In 2016, 9.7% of adults in Long Beach reported being diagnosed with diabetes.